Rampling A, Warren R E, Bevan P C, Hoggarth C E, Swirsky D, Hayhoe F G
J Clin Pathol. 1985 Apr;38(4):445-51. doi: 10.1136/jcp.38.4.445.
Twenty patients with haematological malignancies who developed Clostridium difficile bowel infection or colonisation are described. All isolates of C difficile were toxigenic in vitro and faecal cytotoxin (toxin B) was detected in 20/26 episodes. Ten of 20 episodes with detectable faecal cytotoxin were associated with typical antibiotic associated diarrhoea. In the other 10 episodes (nine patients), there was a severe unusual illness which was associated with detection of C difficile. The unusual features of the illness were pronounced jaundice (total bilirubin greater than or equal to 44 mumol/l), abdominal pain and distension, and initial constipation followed either by diarrhoea or by large bowel stasis. Four of these patients died within seven days. Bacteraemia was often a presenting feature in neutropenic patients subsequently shown to have C difficile. This was not the case in non-neutropenic patients. Bacteraemia was commonly polymicrobial and in two cases C difficile was isolated from blood culture. The clinical implications of recognition of this atypical C difficile associated syndrome are discussed.
本文描述了20例发生艰难梭菌肠道感染或定植的血液系统恶性肿瘤患者。所有艰难梭菌分离株在体外均产毒，26次发作中有20次检测到粪便细胞毒素（毒素B）。20次可检测到粪便细胞毒素的发作中，有10次与典型的抗生素相关性腹泻有关。在另外10次发作（9例患者）中，出现了一种严重的异常疾病，与艰难梭菌的检测有关。该疾病的异常特征为明显黄疸（总胆红素大于或等于44μmol/L）、腹痛和腹胀，起初便秘，随后出现腹泻或大肠淤滞。其中4例患者在7天内死亡。菌血症常为中性粒细胞减少患者的首发特征，这些患者随后被证实感染了艰难梭菌。非中性粒细胞减少患者则不然。菌血症通常为多微生物感染，有2例血培养分离出艰难梭菌。文中讨论了认识这种非典型艰难梭菌相关综合征的临床意义。
